HomeMy WebLinkAboutCiamaricone ,#011 YFFOL
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���` �� Town Hall, 53095 Main Road
ELIZABETH A.NEVILLE
TOWN CLERK % P.O. Box 1179
Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS ® ;., �� Fax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER � ®d Y ��got Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ��
OFFICE OF THE TOWN CLERK
SOUTHOLD VAATEIViAgeBT MED SAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2644 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JANET CIAMARICONE
Address 1 : 585 PACIFIC STREET
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES
EXCAVATION INSPECTION REQUIRED.
Name Of Owner CIAMARICONE, JANET
Mailing Address 1 PO BOX 1631
City St Zip MATTITUCK NY 11952
Property Address 1 585 PACIFIC STREET
City St Zip MATTITUCK NY 11952
Tax Map No. section 141 .00 block 4 lot 13.000
Cross Street LEGION ROAD
Building Permit Number Cross Reference:
Issue Date: 8/28/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
s
,.;r? (Ig Fat 4. ILI2
ELIZABETH A. NEVILLE -� Town Hall, 53095 Main Road
TOWN CLERK 4fr`i `�
� t�a,� _ � P.O. Box 1179
•
REGISTRAR OF VITAL STATISTICS �' '�" Southold, New York 11971
MARRIAGE OFFICER :®� � ���1�, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER = ""4 ,ss22, ,� ,ii Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ' `mss3 �9
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: August 20, 2001
Transmitted herewith is a copy of application No. 2732 for a Cesspool/Septic Tank Construction
Permit submitted by:
Janet Ciamaricone
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and if this office may issue the permit.
Please complete the form below and return it to me.
Linda J. Cooper
* *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments:
Signature
.
Dated
•
,, ....,,,,,,
OFFICE OFETOWNCLERK ,,'�
ME
TOWN OF SOUTHOLD e� D�K
o� C®y-� Application No49 732..„
FJJ7ABETH A.NEVILLE,TOWN CLERK 0
P.O.BOX 1179 Construction
SOUTHOLD,NEW YORK 11971 Alteration
Telephone _,� Q��', $10.00 -Residential
doe,
(631) 765-1800 =-��1 � � $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION •
for
CECEIVED
CONSTRUCTION or ALTERATION pERAIIS 2 0 2001
SEPTIC TANK or CESSPOOL 'fh®sco ICOwv Cleir .
Permit No.
Fee .$
DATE .193lanat
APPLICANT NAME: J fl e C` 1 E 2.\ C on
APPLICANT ADDRESS: 5-85
cA - k
SEPTIC / CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
oa&J\--,cAA.,
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: \ act a ik' . �
OWNER MAILING ADDRESS: c--)0
CAC-. 1/0�1, ( ( CLS--
OWNER
( Q TOWNER PROPERTY ADDRESS: --gd
A„.K.
TELEPHONE NUMBER OF CONTACT PERSON: egqg s
TAX MAP NO. : Section I 1 I Block 0 `"\ Lot M
CROSS STREET: )f-e C \
BUILDING PERMIT NUMBER CROSS REFERENCE:
c 100\36 a-CM\ Ci/AL,6)/J—L--
Signature of Applicant
RECEIVED BY 6,__)L
T wn Clerk's Office
DATE: (� 1
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